Practicebased Research Networks Role in Implementing Practice Cornelius
Practice-based Research Networks’ Role in Implementing Practice Cornelius Thiels, MSIII Change Deborah Graham, MSPH KCUMB, College of Osteopathic Medicine Kansas City, MO AAFP National Research Network Leawood, KS
Contributors • • • Susan Bertram, MSN, Olmsted Medical Center, Rochester, MN Perry Dickinson, MD, University of Colorado - Denver Jessica Huff, MS, University of Colorado - Denver Marge Kurland, RN, Olmsted Medical Center, Rochester, MN Angela Lanigan, MA, AAFP National Research Network, Leawood, KS Deborah Main, Ph. D, University of Colorado - Denver Janet Ann Mc. Andrews, MPH, American Academy of Family Physicians, Leawood, KS Donald Nease, MD, University of Colorado - Denver Paul Nutting, MD, MSPH, Center of Research Strategies, Denver, CO Wilson Pace, MD, AAFP National Research Network, Leawood KS Elizabeth Stewart, Ph. D, AAFP National Research Network, Leawood, KS Barbara Yawn, MD, Olmsted Medical Center, Rochester, MN
Session Goals 1. Discuss PBRNs and integrating change in practice 2. Discuss how participating in practice-based research studies facilitated implementation of change 3. Discuss the techniques used to implement change
Practice-Based Research Networks • A group of ambulatory practices devoted principally to primary care. • Typically, PBRNs draw on the experience and insight of practicing clinicians to identify and frame research questions whose answers can improve the practice of primary care. • The PBRN can produce research findings that are immediately relevant to the clinician.
How do PBRNs help practices integrate research changes into practice? • Help translate research results into practice • Help practices recognize importance of tools and systematic approaches to care • Teach practices to implement change on their own • Help practices learn how to leverage change processes into clinical care • Help practices create long-term sustainable change in their approaches to clinical care
Practice-based Research Networks “Give a man a fish and you feed him for a day. ”
Practice-based Research Networks “Teach a man to fish and you feed him for a lifetime. ”
Implementing Change Three PBRN Studies 1. Depression 2. Postpartum Depression 3. Healthy Interventions 100 90 80 70 60 50 40 30 20 10 0 6 months 12 months 18 months Study A 24 months Study B 30 months Study C 36 months
Implementing Change Three PBRN Studies 1. Depression 2. Postpartum Depression 3. Healthy Interventions
Depression Study Background • Teach practices how to implement and sustain fundamental changes in their delivery systems • Context of improving depression care • 18 month study • Sustainability 2 years after the study ended
Depression Study • Methodology – 18 family medicine and internal medicine practices – 3 weekend collaborative learning sessions – Implemented change between sessions – Material covered both change processes and clinical learning
Depression Study Techniques for implementing change a. Practice Level Improvement Team (IT) b. Reflection Action Process (RAP)
Depression Study a. Practice Level Improvement Team (IT) – What Worked? • Team diversity • Starting IT early • Consistent meetings • Involvement of physician champion
Depression Study b. Reflection Action Process (RAP) Relationship between sustained RAP and sustained tracking/case management
Implementing Change Three PBRN Studies 1. Depression 2. Postpartum Depression 3. Healthy Interventions
Postpartum Depression Study Background • Parent Study: Translating Research into Practice for Postpartum Depression (TRPPD). • Evaluation of implementation of PPD screening, diagnosis, follow-up, and management program in primary care clinics
Postpartum Depression Study • Methodology – 32 family medicine practices nationwide – Randomized to intervention or delayed intervention groups – Intervention was the implementation of practicewide program for screening, diagnosing, followup, and managing postpartum depression – Extensive training and facilitation by central team
Postpartum Depression Study Secondary study • Mid-point semi-structured telephone interviews • Lead physician and study coordinator from 28 primary care practices participating in large clinical trial • Questions around impact on practice of participating in PBRN study
Postpartum Depression Study 6 Major Themes Participation led to: 1. 2. 3. 4. 5. 6. Recognition of importance of tools and systematic approach More effective teamwork and communication Extension of the study tools and systematic approach to other chronic conditions Increased professional self-worth and community recognition Opportunity and support for staff members to “stretch” into new roles Increased research literacy within the practice
Implementing Change Three PBRN Studies 1. Depression 2. Postpartum Depression 3. Healthy Interventions
Healthy Interventions Study Background • Parent Study: Americans in Motion—Healthy Interventions (AIM-HI) • Goals – To encourage primary care clinicians and staff to be fitness role models to patients – To improve clinician’s & practice’s ability to positively affect the fitness of patients – To enhance awareness of practice’s unique ability to promote fitness within their communities • Practices randomized into 2 groups: – “Traditional Office” – “Healthy Office”
Healthy Interventions Study Methods • Traditional Office received training/materials to implement AIM-HI concepts with patients • Healthy Office received training for patients, but were also encouraged to use the tools and strategies within the office in order to create a work culture of wellness. • No real control group
Healthy Interventions Study Results • A non-prescriptive lifestyle behavioral change intervention, AIM-HI, focused on a small changes philosophy and motivating patients to find their own solutions to unhealthy behaviors. • Intervention resulted in clinically significant improvements in weight, physical fitness, and emotional well being for over 20% of the population.
Successful Techniques for Facilitating Sustainable Change I. III. IV. Practice Improvement Teams Reflection Action Process (RAP) Employee wellness teams Long-distance facilitation
What this means for YOU • Making sustainable change is difficult • PBRNs can help practices implement change – These changes can go beyond the scope of the study • PBRNs can facilitate longterm change that are sustainable even after the study has ended 100 100 90 90 90 80 80 80 70 70 70 60 60 60 50 50 50 40 40 40 30 30 30 20 20 20 10 10 10 000 6 months 12 months 18 months 24 months 30 months 36 months Study A
Questions? Cornelius Thiels, MSIII Kansas City University of Medicine and Biosciences Kansas City, MO cthiels@kcumb. edu 404. 219. 6081 Deborah Graham, MSPH AAFP National Research Network Leawood, KS dgraham@aafp. org 913. 906. 6000 ext 3176
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